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General NPI Number Information
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NPI Number | 1508063504
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Entity Type | Organization
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Legal Business Name | WHITNEY FAMILY EYECARE P.C.
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 1221 N. BRAZOS STREET SUITE B
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City | WHITNEY
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State | TX
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Zip | 76692
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Country | US
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Telephone | 254-694-3435
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Fax | 254-694-9968
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Provider Business Mailing Address
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Address Line | PO BOX 2067
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City | WHITNEY
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State | TX
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Zip | 76692-5067
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Country | US
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Telephone | 254-694-3435
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Fax | 254-694-9968
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Authorized Official
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Title or Position | OWNER
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Name | DR. LON WHITFIELD EUBANK
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Credential | O.D.
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Telephone | 254-694-3435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 5119TG
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License Number State | TX
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